BRIEF RESEARCH REPORT article
Front. Surg.
Sec. Visceral Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1538676
This article is part of the Research TopicMicroflora and Bacterial Translocation in Intestinal ObstructionView all 3 articles
Unfavorable microbiological impact of directly duodenal biliary drainage in perihilar obstruction patients: A preliminary report
Provisionally accepted
- 1Department of thoraco-abdominal oncology, National Cancer Institute of Ukraine, Kyiv, Ukraine
- 2Department of General Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
- 3Department of Clinical Microbiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
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Background: Biliary drainage is frequently used in patients with perihilar obstruction. This study was designed to compare the microbiological characteristics of perihilar obstruction patients whose biliary tree was and was not exposed to duodenal fluid due to the mode of drainage.The charts of 71 perihilar obstruction (any etiology causing an obstruction parallel to that of a proximal cholangiocarcinoma according to Bismuth-Corlette classification) patients were evaluated retrospectively. The contacted group comprised 20 patients who underwent either endoscopic stenting or PTBD (percutaneous transhepatic biliary drainage) with duodenal extension, the non-contacted group -51 patients after either external PTBD or surgery upfront.Results: Positive bile cultures results were identified in 95% (19/20) vs. 33% (17/51) of patients (p=0.00001) and multimicrobial growth in 68% (13/19) vs. 24% (4/17) (p=0.007) of the patients in the contacted group and non-contacted group, respectively. Colonization of bile with multidrug (MDR) and extensively drug-resistant (XDR) bacteria was worse in the contacted group: 68% (13/19) vs. 29% (5/17), p=0.02. Significant differences were also found in the frequencies of carbapenem-resistant Enterobacterales (CRE) colonization: in the contacted group, positive CRE culture and PCR were more frequent.The mode of the biliary drainageduodenal vs. directly externalsignificantly modifies the microbiological characteristics of the patients with perihilar obstruction.Catheterization methods that entail continuous exposure of the biliary tree to duodenal fluid are associated with higher frequencies of bactibilia, presence of MDR and XDR bacteria in the bile and intestinal colonization with CRE.
Keywords: Perihilar cholangiocarcinoma, Jaundice, Biliary drainage, Bactibilia, Carbapenam resistant enterobacteriaceae, Multidrug-resistance (MDR)
Received: 03 Dec 2024; Accepted: 17 Jun 2025.
Copyright: © 2025 Rozhkova, Tutuş, Kömeç, Kınacı, Bostancı and Özden. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Veronika Rozhkova, Department of thoraco-abdominal oncology, National Cancer Institute of Ukraine, Kyiv, Ukraine
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